Provider Demographics
NPI:1932504560
Name:SACERDOTE, TIMOTHY (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SACERDOTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 JOHN DOWNEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2906
Mailing Address - Country:US
Mailing Address - Phone:860-229-4830
Mailing Address - Fax:
Practice Address - Street 1:270 JOHN DOWNEY DR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2906
Practice Address - Country:US
Practice Address - Phone:860-229-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical